Lucy's Medicaid Minute
By Lucia Buffaloe, MBA - Director
In June of 2021, CBIZ KA Consulting Services (CBIZ) discovered a denial issue that was affecting many of our New Jersey Medicaid eligibility clients. Due to an internal regulatory change, counties were forced to alter their requirements for approving Emergency Medicaid applications. Previously, physician documentation for specific procedures could be required for billing and payment purposes after an Emergency Medicaid application was submitted; the revised state-wide protocol now required that documentation at the point of application submission. This change led to a significant increase in Emergency Medicaid denials.
CBIZ sprang into action. Immediately we notified clients of the change and held education sessions for their physicians. We worked with our clients to create new electronic processes where this documentation could be gathered and submitted more quickly. We also started meeting with county and state stakeholders to explain why this new regulation was onerous to clients, physicians and patients.
Starting in September, we filed Fair Hearing Requests with several counties. We argued that these denials were in bad faith, harming hospitals and their patients. We presented in front of administrative boards at the county level, with Fair Hearing liaisons at the state level and to Administrative Law Judges. By December, we received notification that our first two denied cases were overturned in our favor.
Due in part to CBIZ’s efforts in appealing these denials and our meetings with stakeholders to explain the negative ramifications of the regulation change, in February the state altered their guidance regarding Emergency Medicaid applications. Now, a new, less onerous form would be required upon submission, one that didn’t require extensive physician documentation with the submitted application. That physician documentation would eventually need to be submitted, but it would no longer hold up the Emergency Medicaid application submission process. With this change, patients will be covered faster and hospitals will be reimbursed without the delays and denials that they experienced in 2021.
CBIZ prides itself on always being at the forefront of issues that are affecting Medicaid reimbursement and we will work to overturn inappropriate denials. We fight for our clients and their patients to get their entitled coverage and reimbursement. If you have any questions about your Medicaid denials or how we can assist in your eligibility process, please contact me at 609-918-0990 or email me at Llucas@cbiz.com.
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